Specialist urologist · Ballito
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Urinary symptom score

Seven clear questions.
One useful starting point.

Complete the International Prostate Symptom Score online or download the original one-page questionnaire.

01

Printable document

Download the I-PSS form.

Prefer a paper copy? Download the original questionnaire, select one answer for every question and bring it to your consultation.

Download I-PSS form · PDFPreview document in a new tab ↗
02

Online questionnaire

Complete it online.

The guided version calculates the seven-question symptom total as you go and sends your answers to the practice.

Start online form ↓
Before you start

Answer according to your experience during the past month. The score describes symptoms and does not provide a diagnosis.

I-PSS questionnaire

Your symptoms,
measured simply.

Choose one answer for each symptom question. Your total will appear automatically before you submit.

01

Patient details

About you

Enter the details shown at the top of the printable I-PSS questionnaire.

02

Symptom score

Seven urinary questions

Choose the single answer that best describes your experience during the past month.

1. Incomplete emptyingOver the past month, how often have you had a sensation of not emptying your bladder completely after you finish urinating?
2. FrequencyOver the past month, how often have you had to urinate again less than two hours after you finished urinating?
3. IntermittencyOver the past month, how often have you stopped and started again several times when you urinated?
4. UrgencyOver the past month, how often have you found it difficult to postpone urination?
5. Weak streamOver the past month, how often have you had a weak urinary stream?
6. StrainingOver the past month, how often have you had to push or strain to begin urination?
7. NocturiaOver the past month, how many times did you most typically get up each night to urinate, from going to bed until getting up in the morning?
Your I-PSS total— / 35

Complete all seven symptom questions

03

Quality of life

How do you feel?

This final question is recorded separately from the seven-question symptom total.

Urinary quality of lifeIf you were to spend the rest of your life with your urinary condition just the way it is now, how would you feel about that?

The score is a structured description of symptoms, not a diagnosis. Dr Padayachee will interpret it together with your history, examination and any appropriate investigations.

Your privacy matters.

This form contains personal health information. Submit it only from a private device and trusted connection. It is sent to the practice for assessment and administration and must not be used for emergencies.